OBJECTIVE--To find indicators of a history of childhood sexual abuse in patients consulting for a gynaecological examination in a general practice. DESIGN--Semistructured interview after a consultation. SETTING--General practice in the city of Oslo, Norway. PARTICIPANTS--Of 117 women aged 20-49 with a gynaeco- logical problem, 85 were interviewed. MAIN OUTCOME MEASURE--History of childhood sexual abuse. RESULTS--24 (28%) of 85 women interviewed by their female GP when consulting for a gynaecological problem reported childhood sexual abuse. In total they reported 32 abusive events, quite different as to the type of assault, the relation to the offender, and the duration. A history of pelvic pain or gynaecological surgery showed a significant association with reported childhood sexual abuse with odds ratios of 4.0 (CI 1.0-15.8) and 4.1 (CI 1.0-17.0), respectively. As adverse sexual experiences may lead to somatization as a coping strategy, certain findings might be indicators of unknown childhood sexual abuse in patients presenting for gynaecological disorders. CONCLUSION--A history of pelvic pain and gynaecological surgery may be indicators of sexual abuse in childhood.
This article embarks from knowledge gained from dialogues with adult men and women in a phenomenological-hermeneutical study of the long-term health impact of sexual boundary violations in childhood. All published texts by the Norwegian novelist Agnar Mykle have been reviewed for the purpose of a reinterpretation, together with scholarly work on his oeuvre and biographical accounts of the author and his first wife. The interpretation has been guided by the assumption that the essays, novels and letters may represent a double text with an embedded coded message. The suggestion is offered that Mykle's work can be read as an attempt at acknowledging and surmounting a basic conflict in the author's own life between, on the one hand, his memories of experiences of boundary violations in childhood and, on the other, a scientific theory of infantile sexuality. It is also claimed that Mykle was silenced by the experience of being tried on pornography charges against one of his novels. The impact of this public humiliation may, in Mykle's perception, have reactivated earlier boundary violations and, as such, have been experienced as a revictimisation.
The patient's expectations, wishes, judgments, and opinions have recently become a topic of interest in medical research. This is partly due to the physician's increasing awareness of an inadequate impact of medical measures, be they preventive, informative, or even curative, on the patient and the general public. It may also be partly due to an increasing criticism on the part of the patient and the general public of the failure of the medical service to respond adequately to the information provided. Consequently, there has recently been increased interest in gaining knowledge about the social aspects of human life relevant to medicine. The measures for securing validity, however, are the traditional rules of reductionist methodology. The author argues that by exploring the domain of culturally constructed meaning with tools based on naturalistic epistemology, the knowledge obtained will be invalid.